Challenging the 30-min rule for thawed plasma

S.O.S. - Save our supplies: Understanding reasons to tackle the challenge of wasted returned blood products

OBJECTIVES

To evaluate the return of blood components across different hospital areas, reasons for the same and suggest preventive strategies which might reduce out of controlled temperature storage (CTS) blood logistics and wastage.

MATERIAL AND METHODS

A retrospective audit was carried out in the department of Transfusion Medicine from January 2019 to December 2022. Data related to returned blood components was compiled using departmental records and blood centre software entries.

RESULTS

A total of 218 instances of returned components were noted and the total number of components returned were 442 (0.4% of all issued components) (38.4% (170) packed red blood cells, 16.2% (72) single donor cryoprecipitate concentrate, 19.6% (87) platelet concentrate and 25.5% (113) fresh frozen plasma). Components were returned back within 30 mins in only 27% (59/218) of all instances . Wards followed by high dependency units/intensive care units were noted to have the highest number of instances (86 (39.4%) and 69 (31.6%) respectively) with emergency department having the least,comprising 19 instances (8.7%). 77.9% (170/218) instances were observed for routine transfusion requests and 44.5% (97/218) of all instances could have been prevented by an appropriate clinical status assessment of the patient.

CONCLUSION

Stakeholders such as clinicians, transfusion laboratory professional and nursing staff must take consolidated efforts to eliminate wastage of blood components. Instances of returned blood components can be targeted by the hospital quality team as a quality improvement project.

Experiences in the use of multiple doses of convalescent plasma in critically ill patients with COVID-19: An early phase 1 descriptive study

Background

At the beginning of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, transfusion of coronavirus disease 2019 (COVID-19) convalescent plasma (CCP) emerged as a potential therapeutic strategy to help patients severely afflicted by COVID-19. The efficacy of CCP has been controversial as it depends on many variables pertaining to the plasma donor and the patient with COVID-19, for example, time of convalescence or symptoms onset. This feasibility and descriptive study aimed to assess the safety of multiple doses of CCP in mechanically ventilated, intubated patients with respiratory failure due to COVID-19.

Methods

A cohort of 30 patients all experiencing severe respiratory failure and undergoing invasive mechanical ventilation in an intensive care unit, received up to five doses of 300-600 mL of CCP on alternate days (0, 2, 4, 6, and 8) until extubation, futility, or death.

Results

Nineteen patients received five doses, seven received four, and four received two or three doses. At 28-day follow-up mark, 57% of patients recovered and were sent home, and the long-term mortality rate was 27%. Ten severe adverse events reported in the study were unrelated to CCP transfusion. Independent of the number of transfused doses, most patients had detectable levels of total and neutralizing antibodies in plasma.

Conclusion

This study suggests that transfusion of multiple doses of CCP is safe. This strategy may represent a viable option for future studies, given the potential benefit of CCP transfusions during the early stages of infection in unvaccinated populations and in settings where monoclonal antibodies or antivirals are contraindicated or unavailable.

Evaluation of bacterial growth, effects on albumin, and coagulation factors in canine fresh frozen plasma administered as continuous rate infusion exposed to room temperature for 12 hours

OBJECTIVES

To determine the risk of bacterial growth and to analyze the stability of albumin and coagulation factors in canine fresh frozen plasma (FFP) units exposed to room temperature (24°C) administered as a continuous rate infusion (CRI) for 12 hours.

DESIGN

Ex vivo study.

SETTING

University teaching hospital and pet blood bank.

ANIMALS

None.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

An FFP CRI was simulated to replicate the standard routine procedure used in dogs. Plasma samples were collected before starting the CRI (H0), after 4 hours (H4), and after 12 hours (H12). Bacterial culture of FFP was performed and albumin concentration and specific activity levels for factors V, VII, VIII, and IX were measured and compared. All plasma culture results were negative. There were no statistically significant differences at any time point in the factor VIII activity (median 105.5% [range, 75.6%-142.0%] at H0; median 107.8% [range, 75.0%-172.7%] at H4; and median 112.1% [range, 81.7%-171.0%] at H12); factor IX activity (median 119.3% [range, 89.1%-175.9%] at H0; median 123.1% [range, 72.5%-172.7%] at H4; and median 118.3% [range, 86.6%-177.5%] at H12); or albumin concentration (median 21.0 g/L [range, 17.0-23.0 g/L] at H0 and median 20.0 g/L [range, 17.0-24.0 g/L] at H12). A slight but significant increase in factor V activity was observed when comparing H0 (median 107.0% [range, 71.0%-159.0%]) to H4 (median 117.7% [range, 71.0%-176.7%]) (P = 0.002) or H12 (median 116.2% [range, 71.0%-191.6%]) (P = 0.001). A slight but significant increase in factor VII activity was observed when comparing H0 (median 115.4% [range, 70.6%-183.7%]) to H4 (median 118.2% [range, 82.7%-194.6%]) (P = 0.005); H0 to H12 (median 128.7% [range, 86.4%-200.0%]) (P < 0.001); and H4 to H12 (P = 0.002).

CONCLUSIONS

FFP CRI at room temperature for 12 hours could be considered safe with regard to risk for bacterial growth and also effective by providing albumin and clotting factors.